Economic evaluation of enhanced asthma management: a systematic review
Main Article Content
Keywords
Asthma, Costs and Cost Analysis, Quality Assurance, Health Care, Health Services Research
Abstract
Objectives: To evaluate and compare full economic evaluation studies on the cost-effectiveness of enhanced asthma management (either as an adjunct to usual care or alone) vs. usual care alone.
Methods: Online databases were searched for published journal articles in English language from year 1990 to 2012, using the search terms ‘“asthma” AND (“intervene” OR “manage”) AND (“pharmacoeconomics” OR “economic evaluation” OR “cost effectiveness” OR “cost benefit” OR “cost utility”)’. Hand search was done for local publishing. Only studies with full economic evaluation on enhanced management were included (cost consequences (CC), cost effectiveness (CE), cost benefit (CB), or cost utility (CU) analysis). Data were extracted and assessed for the quality of its economic evaluation design and evidence sources.
Results: A total of 49 studies were included. There were 3 types of intervention for enhanced asthma management: education, environmental control, and self-management. The most cost-effective enhanced management was a mixture of education and self-management by an integrated team of healthcare and allied healthcare professionals. In general, the studies had a fair quality of economic evaluation with a mean QHES score of 73.7 (SD=9.7), and had good quality of evidence sources.
Conclusion: Despite the overall fair quality of economic evaluations but good quality of evidence sources for all data components, this review showed that the delivered enhanced asthma managements, whether as single or mixed modes, were overall effective and cost-reducing. Whilst the availability and accessibility are an equally important factor to consider, the sustainability of the cost-effective management has to be further investigated using a longer time horizon especially for chronic diseases such as asthma.
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11. Cordina M, McElnay JC, Hughes CM. Assessment of a community pharmacy-based program for patients with asthma. Pharmacotherapy. 2001;21(10):1196-203.
12. Närhi U, Airaksinen M, Tanskanen P, Enlund H. The effects of a pharmacy-based intervention on the knowledge and attitudes of asthma patients. Patient Educ Couns. 2001;43(2):171-177.
13. Lahdensuo A, Haahtela T, Herrala J, Kava T, Kiviranta K, Kuusisto P, Perämäki E, Poussa T, Saarelainen S, Svahn T. Randomised comparison of guided self management and traditional treatment of asthma over one year. BMJ. 1996;312(7033):748-752.
14. Campbell JD, Spackman DE, Sullivan SD. Health economics of asthma: assessing the value of asthma interventions. Allergy. 2008 ec;63(12):1581-1592. doi: 10.1111/j.1398-9995.2008.01888.x
15. Bousquet J, Clark TJ, Hurd S, Khaltaev N, Lenfant C, O'Byrne P, Sheffer A. GINA guidelines on asthma and beyond. Allergy. 2007;62(2):102-112.
16. Drummond M, Sculpher MJ, Torrance GW, O'Brien BJ, Stoddart GL. Basic Types of Economic Evaluation. Methods for the Economic Evaluation of Health Care Programmes. 3rd ed. New York: OUP; 2005.
17. Gray AM, Clarke PM, Wolstenholme JL, Wordsworth S. Applied Methods of Cost-effectiveness Analysis in Healthcare: Oxford: OUP; 2010.
18. World Development Indicators. PPP conversion factor (GDP) to market exchange rate ratio. The World Bank Group; 2014. Available from: http://data.worldbank.org (accesed 21-03-2014).
19. World Development Indicators. Inflation, GDP deflator (annual %). The World Bank Group; 2014. Available from: http://data.worldbank.org (accesed 21-03-2014).
20. Chiou CF, Hay JW, Wallace JF, Bloom BS, Neumann PJ, Sullivan SD, Yu HT, Keeler EB, Henning JM, Ofman JJ. Development and validation of a grading system for the quality of cost-effectiveness studies. Med Care. 2003;41(1):32-44.
21. Walker DG, Wilson RF, Sharma R, Bridges J, Niessen L, Bass EB, Frick K. Best Practices for Conducting Economic Evaluations in Health Care: A Systematic Review of Quality Assessment Tools. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012.
22. Langer A. A framework for assessing Health Economic Evaluation (HEE) quality appraisal instruments. BMC Health Serv Res. 2012;12:253. doi: 10.1186/1472-6963-12-253
23. Au F, Prahardhi S, Shiell A. Reliability of two instruments for critical assesment of economic evaluations. Value Health. 2008;11(3):435-439. doi: 10.1111/j.1524-4733.2007.00255.x
24. Spiegel BM, Targownik LE, Kanwal F, Derosa V, Dulai GS, Gralnek IM, Chiou CF. The quality of published health economic analyses in digestive diseases: a systematic review and quantitative appraisal. Gastroenterology. 2004;127(2):403-411.
25. Peterson LE, Goodman C, Karnes EK, Chen CJ, Schwartz JA. Assessment of the quality of cost analysis literature in physical therapy. Phys Ther. 2009;89(8):733-755. doi: 10.2522/ptj.20080326
26. Davis JC, Robertson MC, Ashe MC, Liu-Ambrose T, Khan KM, Marra CA. Does a home-based strength and balance programme in people aged > or =80 years provide the best value for money to prevent falls? A systematic review of economic evaluations of falls prevention interventions. Br J Sports Med. 2010;44(2):80-89. doi: 10.1136/bjsm.2008.060988
27. Cooper N, Coyle D, Abrams K, Mugford M, Sutton A. Use of evidence in decision models: an appraisal of health technology assessments in the UK since 1997. J Health Serv Res Policy. 2005;10(4):245-250.
28. Tai T, Bame SI. Cost-benefit analysis of childhood asthma management through School-based clinic programs. J Community Health. 2011;36(2):253-260. doi: 10.1007/s10900-010-9305-y
29. Karnick P, Margellos-Anast H, Seals G, Whitman S, Aljadeff G, Johnson D. The pediatric asthma intervention: a comprehensive cost-effective approach to asthma management in a disadvantaged inner-city community. J Asthma. 2007;44(1):39-44.
30. Bolton MB, Tilley BC, Kuder J, Reeves T, Schultz LR. The cost and effectiveness of an education program for adults who have asthma. J Gen Intern Med. 1991;6(5):401-407.
31. Doan T, Grammer LC, Yarnold PR, Greenberger PA, Patterson R. An intervention program to reduce the hospitalization cost of asthmatic patients requiring intubation. Ann Allergy Asthma Immunol. 1996;76(6):513-518.
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Economic evaluation of enhanced asthma management: a systematic review. Pharm Pract (Granada) [Internet]. 2014 Dec. 9 [cited 2025 Apr. 25];12(4):493. Available from: https://www.pharmacypractice.org/index.php/pp/article/view/493
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Economic evaluation of enhanced asthma management: a systematic review. Pharm Pract (Granada) [Internet]. 2014 Dec. 9 [cited 2025 Apr. 25];12(4):493. Available from: https://www.pharmacypractice.org/index.php/pp/article/view/493